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And should the state impose limits on medical malpractice awards, or take a more incremental approach at relieving doctors of climbing insurance rates?

Gregoire has a platform she claims would provide incremental reforms without sacrificing the safety net. She says Rossi has a record of abandoning the vulnerable.

Rossi counters Gregoire's plan is big-government intervention, while his would be good for business and the economy.

"I want to make sure that we have as many companies in this state offering health insurance as we can," Rossi told a business group recently.

Both candidates have used doctors as props at dueling media events as they try to position themselves on the issue.

Health care will certainly be a top issue facing state politicians when the Legislature convenes in January. They'll face a budget shortfall of $1 billion or more, according recent figures from state budget officials. Insurance programs for poor and state workers will likely be on the table.

And some of Olympia's most powerful lobbies -- insurers, drug companies, lawyers, doctors, business groups and patient advocates -- will face off in a renewed battle over malpractice reform.

Dealing with double-digit growth in malpractice premiums has proven among the most polarizing issues facing politicians. Physicians' groups, insurers and Republicans complain that huge jury awards have driven premiums so high that they have forced doctors out of business.

Consumer advocates, lawyers groups and Democrats support a more incremental plan. The two sides wound up in stalemate earlier this year.

Legislators have also struggled over how to reduce the burden of skyrocketing drug prices on the elderly, the disabled and the state budget.

And there's long-standing debate over how to cover the uninsured. At least 550,000 Washingtonians lack insurance, costing taxpayers and those with coverage more than $318 million each year in subsidized services, according to the state insurance commissioner.

Insurers and businesses blame state regulations. They want legislators to repeal requirements that insurers pay for certain treatments, enacted to protect patients, some after heavy lobbying from chiropractors and other groups.

Rossi and Gregoire, the attorney general, are far apart on each of those three issues.

Rossi's plan

"I want to make sure you have affordable health care, but also make sure you have access to doctors," Rossi said at a recent debate. Rossi often tells backers and reporters that Washington neurosurgeons are paying $300,000 for malpractice insurance.

While that may be true for some doctors, it would be extraordinary.

A neurosurgeon's typical premium for $1 million in coverage is between $90,000 and $100,000, according to the insurance commission. Those who want the maximum coverage would pay about twice that.

Siding with business and insurers, Rossi wants $250,000 maximums on non-economic damages, which the Medical Association plans to pursue through an initiative next year. Simply put: economic damages pay for the wheelchair and gear you need if you are paralyzed by a bad doctor, non-economic damages compensate you for the fact you'll never walk. Many states have such caps. But, unlike Washington, most states also allow for punitive damages.

Rossi also supports repealing some insurance mandates, which he says have driven all but a "few" companies out of the Washington market. There are 14 carriers selling plans to businesses and eight selling to individuals, according to the Insurance Commission.

"You may not want acupuncture, but you're paying for it," he says on the stump, referring to a requirement that some insurers pay for alternative treatments.

Not all of the mandates are applicable to all insurance plans, and some only require insurers to offer certain kinds of coverage. Some of the mandates include mammograms, chemical dependency treatment and emergency services.

Rossi's record on health insurance has become a point of contention.

Gregoire criticizes him of unsuccessfully proposing to "cut" 40,000 poor children from state insurance programs in 2003, when he was Senate Republicans' lead budget negotiator. Rossi argues it was a proposal to slow growth in the program, not cut kids off it.

It's unclear what would have happened. At the time, nearly 40,000 kids were enrolled based on the income qualifications that Rossi wanted to restrict, according to state officials. Presumably, they would have lost coverage that July.

Rossi's critics accuse him of voting against prescription drug relief for seniors and the Patients Bill of Rights, a consumer protection act. He repeatedly voted against both at first, but supported them in the end.

In 2003, Democrats wanted to establish the nation's most ambitious bulk-buying consortium, open to government, citizens, unions and companies. The consortium would have covered a restricted list of drugs.

Republicans offered a much smaller proposal to create of a discount card for seniors and the disabled. It was projected to save 6,000 Washingtonians less than three percent of their drug costs.

Rossi eventually voted for that bill, immediately after supporting an unsuccessful proposal to gut it. Shortly after the bill passed, the federal government approved its own Medicare discount program. Since then, only 10 people have signed up for the state discount, according to the Washington Health Care Authority.

Rossi said he voted against the bill in hopes it could go back to negotiations for improvements. "In the end, that was what we were going to get, so I was going to support it," Rossi said.

Asked if he's being disingenuous boasting of his work for drug relief, Rossi noted that the AARP named him a "senior star" that year.

It was not an award, but simply a nod to some lawmakers in a newsletter column, clarified Lauren Moughon, lobbyist for the group.

"It's confusing to me that now he's claiming credit," she said. "Once it was clear it was going to pass, Sen. Rossi and a bunch of other Republicans came over and supported this bill.

"His record is confusing at best."

Democrats also accuse Rossi of voting against additional funding for breast and cervical cancer. In 1998, he voted against such a such a budget amendment in committee, but he later supported it on the floor. In 1999 and 2001, he advocated such funding increases.

Gregoire's plan

Gregoire promises she'd ensure all Washington children have health insurance by 2010, paid for with savings in other programs. For example, Gregoire says she'd "explore" pooling Washington's drug purchases with other states and "fight" for permission to buy cheaper Canadian drugs.

While Rossi would repeal insurance mandates, Gregoire says she'd advocate for requirements that they also cover disease management.

And Gregoire says she'd use a $500 million bonus in the national tobacco settlement to establish a "life sciences" fund to subsidize public/private work in areas such as embryonic stem cell research, agricultural research, nanotechnology, information technology and engineering. It's a centerpiece of Gregoire's job development plan.

Rossi has called that an "about face" on Gregoire's 2003 opposition to investing a portion of the settlement into biotechnology and biomedical research, with an emphasis on smoking-related illnesses.

Back then, Elaine Rose, of Gregoire's office, testified that judgments from such lawsuits , "ought to go back towards the people who are harmed. If you can't give it back to the people individually who are harmed, you ought to try to least keep it within the realm for the reasons of which the lawsuit was brought."

Gregoire's campaign says the difference now is her plan would not tap into annual tobacco payments, but would use a one-time bonus Washington expects to receive because Gregoire helped negotiate the 1998 settlement. The settlement was widely praised, although some, including anti-smoking organizations, felt it let Big Tobacco off too easy.

Gregoire claims her plan would bring 40,000 to 70,000 new life sciences jobs to Washington.

"That seems wildly optimistic to me," said Joe Cortright, a Portland economist who has studied the biotechnology industry. "There's no biotech center in the U.S. that has that many jobs in it."

Gregoire's campaign struggled to show the math behind the figure. They referred questions to Explore Life, a public-private consortium established to accelerate the region's biotechnology industry. Studies commissioned by that group produced even higher potential job growth, although they were not reviewing Gregoire's plan specifically.

Gregoire has also attributed the figure to a leading northwest scientist, who did not return calls seeking comment. Asked during a recent debate whether job growth projections are better left to economists, Gregoire avoided the question.

Gregoire has also criticized Rossi for approving a nursing home tax in the 2003 budget, which was approved by the Democratic-controlled state House and Democratic Gov. Gary Locke. However, the nursing home industry requested that tax hike in hopes it would increase federal subsidies.

Despite Gregoire's criticism that the subsidies have yet to materialize, that's out of Rossi's hands. Rossi retired from the Senate later that year.

The state is still waiting to hear from the feds on the subsidy request, according to the state Department of Social and Health Services.